President of Quebec’s residents says Bill 83 is ‘a harmful restriction for young doctors’

How to stop the rise of private healthcare? The Quebec government is proposing to force medical students and residents to practice within the Quebec public system after the end of their studies. This is an objective denounced by the Fédération des médecins résidents du Québec (FMRQ).On Dec. 3, 2024 Health Minister Christian Dubé tabled Bill 83 “promoting the practice of medicine within the public health and social services network.” The text includes wording requiring all new physicians to participate in the public system for five years under penalty of fines of up to $200,000, but also for certain medical students and residents to sign an undertaking to practice in Quebec after their training.The FMRQ, which brings together 4,000 young doctors across the province, immediately expressed concern about the consequences of such measures. It was also heard in parliamentary committee on Feb. 6 on this subject. Profession Santé, a sister brand to the Medical Post in Quebec, takes stock with its president, Dr. Ghassen Soufi.Q: Why are you worried about Bill 83?We were very surprised by the announcement of this bill in the fall of 2024—we were not consulted. When we were heard, in 2023, regarding the bill to make the health and social services system more efficient—which led to the creation of Santé Québec—we had already opposed a clause aimed at requiring future doctors, upon entering residency, to practice in the region at the end of their training. The minister then agreed with us. It is a little frustrating to see this idea resurface today.We 100% support the idea behind the bill, because we want a strong public health system. But the method used by the government is not the right one to achieve this.Also read: Bill 83 forcing new doctors to practice in public criticizedQ: Are you seeing a flight of residents to the private sector?Today, all resident physicians practice in the public system, and the overwhelming majority want to stay there afterwards. A residency lasts between two and seven years, and some people will seek sub-specialties afterwards. All these years are spent within the public network, and it is not a question of a debt to repay to society in order to be free afterwards. When you are trained in medicine and work in the public sector, providing care to the Quebec population is not measured in terms of the number of years of service or the number of hours owed; it is something that accompanies our practice.Bill 83 is a new and deleterious restriction for young doctors and adds another layer of bureaucracy before they even begin practice.We already have to juggle restrictive measures, such as regional medical staffing plans for family doctors, medical staffing plans for specialists, special medical activities. All of this regulates the entry into practice of new doctors and makes finding a position much more complicated.Q: What do you think would be good solutions to keep young doctors in the public sector?We must ask ourselves why people leave the public service in the first place. Is it a question of practice, resources, lack of positions, inter-regional differences?Our members often tell us that they cannot find a position, that they are forced to move, to do additional training, or to enter the private sector in order to be able to practice in the region where they want to settle. Even if there is a need in clinical terms, some environments do not have the resources necessary to accommodate them. They also need predictability, to know what awaits them, to be able to organize their personal lives and adapt their practice. This bill does not address these problems at all.Almost all professionals see a flight to the private sector , this is not a problem specific to doctors. The public health system is a team effort. Forcing new doctors to practice there without the positions and resources being available leads nowhere. If the government sincerely wants to rebuild the public system, we will be the first to answer the call.Read: Ban on private medicine: CMQ proposal surprises and disappoints those concernedQ: What about commitments to practice in Quebec that could concern certain groups of students and residents?There are almost no details on the content of these famous contracts that could be issued at the start of medical studies or residency. This is very problematic and worrying, since it could take on a potentially discriminatory aspect by imposing future practice conditions on people who are just beginning their studies.In five, seven or even ten years, a lot can happen on a personal and professional level. Some people might have to move to other provinces, and it's hard to predict what might happen then. We also fear that future students or doctors will no longer want to come and practice in Quebec because of this type of measure.We understand the government's concerns, which say “we train doctors who will work elsewhere.” There is obviously a social responsibility to working in Quebec. But mobility is intrinsically linked to the medical field: Quebec resident doctors can go and do their training elsewhere, then stay there or come back. Some residents also come from other provinces and choose to continue practicing in Quebec.Don’t miss: Private medicine: your opinion on the College’s recommendationsQ: Where are the negotiations for the renewal of your collective agreement which expired four years ago?We are still in discussions, it has been more than two years now. As we announced at the end of fall 2024, we are continuing our efforts to move towards the essential services strike, since we still do not have a serious offer from the government. But we are not there yet.Given the nature of the negotiations with other health professionals, we did not expect the government to be more open with us. So we are neither disappointed nor surprised. However, what we find unfortunate is that our work is not respected at its true value: resident physicians perform technical procedures, receive patients in consultation independently, work an average of 70 hours per week, sometimes up to 19 consecutive days (the maximum number of consecutive work days that employers can require under the current agreement, Editor's note). Nearly three-quarters of our members say they feel completely exhausted at the end of their work day, according to our 2023 survey. And in the end, they are told that they are only learners who do not really contribute to the health system.Read: For or against private medicine? Q: What about the possible addition of a third year of residency, which the College of Family Physicians of Canada backtracked on at the end of 2023?From what we understand, some faculties are still working to set up structures that are similar to a third year of residency. The FMRQ has always been in favour of voluntary training opportunities for family medicine graduates, in order to acquire certain techniques in obstetrics, drug addiction or mental health, for example. This can be very relevant for extending a residency and consolidating their future practice.But we strongly oppose the idea of a third year that resembles the first two, imposed on all family medicine residents. It is not relevant, and it does not correspond to the educational value of the residency. Comments collected before the holding of consultations on Bill 83 at the National Assembly on February 6 and 11, 2025.This item originally appeared in French in our sister media brand in Quebec, Profession Santé.

President of Quebec’s residents says Bill 83 is ‘a harmful restriction for young doctors’

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